NPIMap

Organization Active NPI

Skin Win Dermatology PC

  • Dermatology Physician
  • Williston, ND
National Provider Identifier
1992343198
Registry record updated Jul 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SKIN WIN DERMATOLOGY PC
Practice address
1213 15TH Ave W Ste 102
Williston, ND 58801-3800
Phone
(917) 545-8637
NPI assigned
Dec 18, 2019
Last updated
Jul 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel Hoffman, MDNPI 1205006897
Title
President
Phone
(917) 545-8637

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

1213 15TH Ave W Ste 102
Williston, ND 58801-3800

Mailing address

66 Niagara St
Denver, CO 80230-6711

Other practice location 1

66 Niagara St
Denver, CO 80230-6711
Phone (917) 545-8637

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, KS, NM, WI4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20200729002949 ND Part B Supplier - Clinic/Group Practice 6901221597 Receives reassigned benefits from 9 practitioners
Practice locations: Bismarck, ND; Williston, ND; Dickinson, ND; Minot, ND
O20220912003247 KS Part B Supplier - Clinic/Group Practice 6901221597 Receives reassigned benefits from 3 practitioners
Practice locations: Liberal, KS
O20250110003395 NM Part B Supplier - Clinic/Group Practice 6901221597 Receives reassigned benefits from 2 practitioners
Practice locations: Hobbs, NM
O20260415002370 WI Part B Supplier - Clinic/Group Practice 6901221597 Receives reassigned benefits from 2 practitioners
Practice locations: Rhinelander, WI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D2213935Skin Win Dermatology1213 15TH Ave W Suite 102, Williston, ND 58801ComplianceMar 12, 2028

National Provider Directory

National Provider Directory

Locations

2111 Landmark Cir NW
Ste D
Minot, ND 58703
Phone (701) 800-5110

7 N Brown St
Rhinelander, WI 54501

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ez_00276

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594684800000",
    "number": "1992343198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 NIAGARA ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802306711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 15TH AVE W STE 102",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013800",
            "telephone_number": "917-545-8637"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "66 Niagara St",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802306711",
            "country_code": "US",
            "telephone_number": "917-545-8637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SKIN WIN DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-18",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-545-8637",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williston, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.